Your Guide to Diabetic Nerve Decompression Surgery: Common FAQs

You've been told your diabetic neuropathy is "progressive and irreversible." But what if there's another explanation for your symptoms? What if you actually have nerve compressions that can be surgically treated? Many patients with diabetes suffer from both diabetic neuropathy and treatable nerve compressions, yet the compression problem often goes unrecognized.

Dr. Eric H. Williams, a fellowship-trained peripheral nerve surgeon in Baltimore, has helped many patients with well-controlled diabetes find relief from pain and improve sensation caused by nerve compressions. These frequently asked questions address the most common concerns patients have about this life-changing surgical approach.

Am I a Candidate for Surgery if I Have Diabetic Neuropathy in Both Feet?

This is exactly why nerve decompression surgery for diabetic patients was developed. Almost all patients with nerve compressions related to diabetes experience symptoms in both feet, so bilateral symptoms don't disqualify you from treatment.

The critical distinction here is understanding what we're actually treating. We're not attempting to cure diabetic peripheral neuropathy itself. Instead, we're addressing nerve compressions that occur in diabetic patients who have been misdiagnosed as having untreatable diabetic neuropathy.

Your candidacy depends on having positive findings during physical examination, particularly a positive Tinel sign at areas where nerves commonly become compressed. These areas include the common peroneal nerve, deep peroneal nerve, superficial peroneal nerve, and tibial nerve in the tarsal tunnel.

If you have positive physical examination findings, you may be a candidate for nerve decompression regardless of whether you have symptoms in one foot, both feet, or even all four extremities, including your hands. The key is demonstrating that compression exists at specific anatomical locations.

When multiple nerve compressions exist, Dr. Williams typically focuses on one leg first. Once you've experienced improvement in the first limb, surgery on the opposite side can be scheduled. In rare circumstances, both sides might be addressed simultaneously, particularly for patients traveling from great distances.

Is Diabetic Neuropathy Surgery Safe for Older Adults?

While Dr. Williams typically prefers patients to be under 85 years old, this guideline reflects the natural aging process of nerve regeneration rather than safety concerns. Nerves in a 25-year-old simply heal differently than nerves in a 90-year-old. As we age, our bodies face additional challenges, including cardiovascular disease, reduced blood flow, and other diabetes-related complications that can affect surgical outcomes.

However, some patients over 85 may still be excellent surgical candidates if they maintain good overall health and have strong support systems. Conversely, younger patients with significant health issues might not be suitable candidates. Your individual health profile matters more than the number on your birth certificate.

The key is honest communication about realistic expectations. If you're older, you may not achieve the same results you might have experienced 10 years earlier. But for many patients, even modest improvement in pain and function makes surgery worthwhile.

How Long Does It Take to Recover From This Type of Surgery?

Recovery involves several different timelines that patients need to understand. There's the healing of the surgical incision itself, your return to normal activities, and the regeneration of the compressed nerves.

For incision healing and post-surgical soreness, most patients feel significantly better within three to six weeks. However, this can vary according to the procedure performed and your overall health. 

Your ability to walk returns relatively quickly. Most patients can hobble around by the second or third week and should be off crutches by the third week. However, returning to work depends entirely on your occupation. An office worker might return within a week, while someone in heavy construction should plan on being away from physically demanding activities for three months.

The most variable aspect of recovery involves nerve regeneration and symptom relief. This can range from immediate improvement the day after surgery to gradual progress over the course of an entire year. The outcome depends on how severely compressed your nerves were before surgery and how long the compression existed.

About 85% of patients notice substantial improvements in sensation and pain within six months. This timeline is based on the biological fact that nerves regenerate at approximately one millimeter per day, or about one inch per month. However, many patients experience pain relief much earlier than the complete return of sensation.

For patients who are slow to recover, Dr. Williams allows up to a full year for improvement. If no progress is evident within a year, further improvement becomes unlikely. 

Is It Ever Too Late for Surgery?

The presence of a positive Tinel sign is more important than how long you've had symptoms. If you have a positive Tinel sign during examination, you maintain approximately an 85% chance of improvement after nerve decompression surgery, regardless of how long your symptoms have persisted.

The Tinel sign is that characteristic "funny bone" sensation you get when tapping over a compressed nerve. It indicates that the nerve, may be compressed, and still retains the potential for recovery. Without this positive finding, success rates drop dramatically, which is why Dr. Williams typically doesn't recommend surgery in these cases.

If you've been told your condition is "too advanced" for treatment, seek evaluation from an experienced peripheral nerve surgeon who can properly assess for treatable nerve compressions.

How Does Surgery Help Reduce My Need for Pain Medications?

One of the primary goals of nerve decompression surgery is to reduce or eliminate your dependence on pain medications. Medications like gabapentin, Lyrica, amitriptyline, and narcotics can provide temporary symptom relief, but they don't address the underlying nerve compression causing your pain.

The vast majority of patients who undergo successful nerve decompression surgery can significantly reduce or completely eliminate their pain medications. For these patients, surgery addresses the root cause of their discomfort, making medication unnecessary.

A smaller percentage of patients find that while they still need some medication after surgery, their medications become much more effective. Before surgery, these patients often describe their medications as barely helping despite maximum doses. After nerve decompression, even smaller doses of the same medications provide excellent pain control.

This improved medication effectiveness occurs because the underlying nerve compression has been relieved. When a nerve is no longer being pinched, medications designed to calm nerve pain may work better to help with residual symptoms.  

Why Does My Pain Feel Different After Surgery?

After surgery, it’s completely normal for your pain to feel different than it did before the procedure. Understanding the types of sensations you may experience can help you recognize what’s expected and what signals healing is underway.

You may encounter three distinct types of post-surgical sensations:

• Normal surgical pain. This feels like soreness or achiness around the incision site and generally resolves within three to six weeks as your skin and tissues heal. Most patients can distinguish this surgical discomfort from their original nerve pain.
• Persistent original symptoms. You may continue to experience some of your original nerve-related symptoms while waiting for the compressed nerves to regenerate and heal. This improvement timeline varies significantly among patients but generally follows the nerve regeneration timeline we discussed earlier.
• Nerve regeneration discomfort. The most confusing situation occurs in patients who had primarily numbness rather than pain before surgery. These patients often experienced burning pain years earlier, but as their nerves became more severely compressed, the pain faded and was replaced by profound numbness and balance problems. This regeneration pain is actually a positive sign, indicating that your nerves are recovering, though admittedly, this can be a bit challenging for patients for a period of time.   

When Can I Drive After Surgery?

Your ability to return to driving depends on several factors, including which foot was operated on, your pain level, and whether you're taking medications that might impair your reflexes.

For left foot procedures, many patients can drive when their pain is well-controlled, they're not taking medications that cause drowsiness, and they can safely slam on the brake pedal if needed. This typically occurs within two to four weeks after surgery.

Right foot procedures generally require a longer wait since your right foot controls both the gas and brake pedals. Most patients need to wait three to four weeks minimum before driving safely, though some may need longer depending on their specific situation and recovery progress.

The most important considerations are your reaction time and ability to respond to emergency situations. You should be able to move your foot quickly and forcefully if you need to brake suddenly. Pain, medication side effects, or weakness that interferes with these abilities means you're not ready to drive.

Dr. Williams recommends using common sense and erring on the side of caution. If you have any doubt about your ability to drive safely, wait longer or arrange for alternative transportation. The goal is to ensure both your safety and the safety of others on the road.

What Happens if Surgery Doesn't Work for Me?

While nerve decompression surgery has high success rates, some patients don't achieve the results they hoped for. Understanding why this happens can help set realistic expectations and guide future treatment decisions.

Several factors can contribute to less-than-optimal outcomes:

• Inadequate surgical technique. The surgery wasn't performed correctly due to inadequate training or experience. This is why Dr. Williams strongly recommends seeing only fellowship-trained peripheral nerve surgeons for these procedures.
• Extensive nerve damage. The nerves may have been compressed for such a long period that they've lost the ability to regenerate, despite successful decompression.
• Incorrect diagnosis. Some patients may have been misdiagnosed, meaning they didn't actually have treatable nerve compressions, making the surgery unlikely to help from the beginning.
• Multiple compression sites. There could be other nerve compressions upstream or downstream from the surgical site, such as spinal problems or other peripheral nerve entrapments, that continue to cause symptoms even after successful surgery at one location.

If you've had nerve decompression surgery elsewhere without success, Dr. Williams can sometimes determine whether the procedure was performed adequately. Revision surgery is possible in some cases, though outcomes are generally not as predictable as primary surgery, and the recovery process is typically longer and more involved.

This is why choosing an experienced, fellowship-trained peripheral nerve surgeon for your initial surgery is so important. While revision surgery is an option, getting the best possible result from your first procedure is always preferable.

Can I Travel From Out of State for This Surgery?

Dr. Williams regularly treats patients from across the country and has developed systems to make this process as convenient as possible for traveling patients. These procedures are performed on an outpatient basis, so you won't need extended hospitalization.

You will need to arrange for a local healthcare provider to remove your surgical dressing about one week after surgery. This could be your primary care physician, a nurse practitioner, or another qualified medical professional. This person should be willing to coordinate with Dr. Williams if any concerns arise during your recovery.

Dr. Williams makes himself available for questions, concerns, or complications through phone, text, or additional telemedicine visits. He believes in maintaining close contact with all patients, regardless of their geographic location, throughout the recovery process.

While most post-operative care can be managed remotely, you should understand that complications or concerns might require you to return for an in-person evaluation. Though rare, some situations can't be fully assessed through telemedicine alone.

The key to successful out-of-state treatment is having a local medical support system and being prepared for the possibility of additional travel if issues arise. Most patients find this arrangement works well, but it requires commitment and planning on your part.

Before scheduling surgery, Dr. Williams will discuss your specific travel situation and help you understand what arrangements need to be made to ensure the best possible outcome.